Vaginal vault smears – ‘know more – do less’: a questionnaire survey of primary health care practitioners H. Stokes-Lampard*, S. Wilson   , T. Allan à , C. Waddell § and S. Kehoe – *University of Birmingham and General Practitioner, The Cloisters Medical Practice, Lichfield, UK,   Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK, à St Bartholomew’s School of Nursing and Midwifery, London, UK, § Birmingham Women’s Hospital NHS Trust, Birmingham, UK and – John Radcliffe Hospital, Oxford, UK Accepted for publication 25 April 2005 H. Stokes-Lampard, S. Wilson, T. Allan, C. Waddell and S. Kehoe Vaginal vault smears – ‘know more – do less’: a questionnaire survey of primary health care practitioners Background: The vaginal vault smear is a test for cellular atypia in women who have undergone a hysterectomy. In asymptomatic women the test has poor sensitivity and specificity. Current guidelines recommend: vault smears should not be used after hysterectomy for benign pathology; two vault smears (6 and 12 months postsurgery) should be taken when there is evidence of completely excised CIN II/III in the specimen. Aim: To describe primary health care professionals’ self-reported knowledge and behaviour relating to the use of vault smears. Design of Study: Questionnaire. Setting: South Birmingham. Methods: Postal questionnaire survey to primary health care professionals (general practitioners and practice nurses, n ¼ 424). Results: Response rate 80.0%, completed response rate 68.9%. Mean knowledge score was 7.3 out of possible 12 (SD 1.9); range 0–10. No significant differences were observed between GPs and practice nurses in knowledge scores, although differences were noted in the frequency of performing vault smears. An inverse relationship was observed between frequency of performing vault smears and level of knowledge about the test. There was a positive association between requesting further information and the ‘knowledge score’. Only 11% correctly answered a question based on current guidelines. Conclusions: Knowledge of current guidelines was poor. Those who undertook fewest vault smears appeared best informed. This suggests that if all primary care professionals practised according to current guidelines, the number of vault smears performed may be reduced. Unnecessary vault smears may cause additional anxiety in women and have financial consequences for the NHS. Keywords: post hysterectomy, vault smear, primary care, questionnaire, survey, guidelines Introduction The purpose of cervical screening is to reduce mortal- ity through the identification of cytological abnormal- ities before they reach the stage of clinically invasive carcinoma. 1 The Papanicolaou (Pap) smear is used to detect the early dysplastic cell changes that may be precursors of invasive disease. Population-based cer- vical screening is seen as a successful public health measure. Pap smears of the vaginal vault (vault smears) are a means of determining the presence of invasive and/or pre-invasive disease of the lower female genital tract where the cervix uteri has been completely removed. 2 Approximately 20% of women in the UK have had a hysterectomy by the age of 65, Correspondence: Dr Sue Wilson, Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, UK. E-mail: s.wilson@bham.ac.uk Cytopathology 2005, 16, 244–251 ª 2005 Blackwell Publishing Ltd 244